解放军医学杂志2025，Vol.50Issue(5)：536-544,9.DOI:10.11855/j.issn.0577-7402.0620.2025.0114
外周-室温体温梯度对脓毒症患者28 d内死亡的预测价值:一项单中心前瞻性观察性临床研究
Predictive value of toe-to-room temperature gradient for 28 d mortality in sepsis patients:a single center prospective observational clinical study
摘要
Abstract
Objective To investigate the predictive value of temperature gradients on the mortality of sepsis patients and their correlation with fluid input.Methods By means of a prospective observational method,154 patients with sepsis or septic shock admitted to the Department of Critical Care Medicine at Nanfang Hospital,Southern Medical University from November 2019 to November 2021 were included as research subjects.They were divided into a survivor group(n=118)and a non-survivor group(n=36)according to whether they survived within 28 days.The core-to-toe temperature gradient(CTTG)and toe-to-room temperature gradient(TRTG)were monitored and calculated immediately upon admission to the intensive care unit(ICU)and 6 hours after admission.Receiver operating characteristic(ROC)curve was used to explore the predictive value of temperature gradients on mortality,and multivariate Cox regression analysis was performed to explore the risk factors of 28-day mortality in sepsis patients.The results were verified through survival analysis.Correlation analysis and multivariate analysis of variance were used to explore the correlation between temperature gradients and fluid input,as well as noradrenaline doses.Results Among the 154 patients,118 survived within 28 days(survivor group),and 36 died(non-survivor group).ROC curve and multivariate Cox regression analysis showed that a toe-to-room temperature gradient of≤5.35℃within 6 hours after admission was a risk factor for 28-day mortality.Compared with patients with a high toe-to-room temperature gradient(>5.35℃),patients with a low toe-to-room temperature gradient(≤5.35℃)had a 2.74-fold increase in the risk of 28-day mortality(P=0.004,95%CI 1.54,9.12).The CTTG and TRTG upon admission to the ICU and 6 hours after admission were not significantly associated with fluid input or noradrenaline doses(P>0.05).Conclusions A toe-to-room temperature gradient of less than or equal to 5.35℃within 6 hours after ICU admission is a risk factor for 28-day mortality in sepsis patients.The improvement of temperature gradients at different time points is not associated with fluid input.关键词
脓毒症/体温梯度/液体复苏/皮肤温度Key words
sepsis/temperature gradient/fluid resuscitation/skin temperature分类
临床医学引用本文复制引用
李露兰,刘易林,刘勇,陈少武,胡鸿彬,曾振华..外周-室温体温梯度对脓毒症患者28 d内死亡的预测价值:一项单中心前瞻性观察性临床研究[J].解放军医学杂志,2025,50(5):536-544,9.基金项目
This work was supported by the Clinical Research Special Foundation of Nanfang Hospital,Southern Medical University(2018CR047),and the Clinical Research Special Grant Fund of Wu Jie-Ping Medical Foundation(320.6750.18431) 南方医科大学南方医院临床研究专项基金(2018CR047) （2018CR047）
吴阶平医学基金会临床科研专项资助基金(320.6750.18431) （320.6750.18431）
